Mucosal-Local

Note:

Many of cocaine's systemic adverse effects are due to excessive sympathetic activity and may be caused by rapid absorption, decreased patient tolerance, or, rarely, hypersensitivity. Toxic reactions are relatively uncommon with appropriate use of usual clinical doses.

The fatal dose of cocaine has been reported to be 1.2 grams. However, patient sensitivity to the effects of the medication is highly variable; adverse effects have been reported with as little as 20 mg.

Acute toxicity may occur very rapidly. Manifestations of systemic cocaine toxicity may occur in 3 stages (early stimulation, advanced stimulation, and depression). Although many of the signs and symptoms of early stimulation would not necessarily require medical intervention under other circumstances, their occurrence following use of cocaine indicates that prompt action is required, because progression from one stage of toxicity to the next may be very rapid.

The following side/adverse effects have been selected on the basis of their potential clinical significance (possible signs and symptoms in parentheses where appropriate)—not necessarily inclusive:

Those indicating need for medical attention

Signs and symptoms of systemic toxicity

Early stimulation Cardiac/cardiovascular effects, including increased blood pressure increased heart rate premature ventricular contractions (irregular heartbeat) vasoconstriction chills and fever CNS effects, including agitation excitement nervousness restlessness apprehension irritability confusion dizziness or lightheadedness hallucinations sudden headache inability to remain still mood or mental changes, including elation or euphoria dysphoria or dysphoric agitation paranoid ideation or psychosis preconvulsive movements talkativeness generalized tics or twitching of small muscles —especially of the face, fingers, or feet gastrointestinal effects, including abdominal pain nausea or vomiting grinding of teeth increased sweating rapid breathing unusually large pupils —sometimes with bulging of eyes

Note:

Hallucinations may be auditory, gustatory, olfactory, visual (e.g., ``snow lights''), and/or tactile (e.g., formication [``cocaine bugs''], which may induce picking or stroking movements).

Tachycardia occurring after low doses of cocaine may initially be preceded by bradycardia